By Dr. Lucas Otieno Tina

There’s a common saying in my community: ‘‘It’s better to start early than go to a witch doctor.” By this, we mean, it’s better to prevent the disease than to treat it when it’s often too difficult, or too late.

My community is a town called Kisumu, which is located in western Kenya along the shores of Lake Victoria. There, I work as a physician and researcher at the Kenya Medical Research Institute/US Army Medical Research Unit/Kenya collaboration program, otherwise known as the KEMRI/Walter Reed Project.

I work to protect children against big killers 

Every day, I work to protect African children against the big killers in our region: pneumonia, diarrheal diseases and—particularly for us at the KEMRI/Walter Reed Project—malaria. And every day, when I see these children and their parents suffering, I feel compelled to do something. First, to treat the disease, and second to prevent it.

And that is where we find the beauty of immunization with vaccines. We’ve learned from various diseases, including the classic cases of polio and smallpox, that prevention is better than cure. Vaccination, typically easier and cheaper than curing, averts the suffering of children and the burden on the family and community.

Across the road from my research center, you will find the Kombewa District Hospital, where we treat the participants in our clinical trials and other members of the public. In the course of my work, I have repeatedly witnessed the problems of poverty, lack of access to proper healthcare, and resource limitations. It’s been especially troubling to watch the medical personnel and facilities struggling with illnesses that are mostly preventable and treatable. These are primarily infectious diseases—malaria, tuberculosis, diarrhea, and HIV/AIDS—and malnutrition.

I have gained invaluable experience in several large trials

We’ve known for 40 years that a vaccine against malaria is biologically feasible. The KEMRI/Walter Reed Project has been in the thick of this research and has worked on malaria and various vaccine candidates for many decades. Through my work with them, I have gained invaluable experience in several large trials of malaria vaccines. I consider our contribution a great achievement given that a malaria vaccine has the potential to change the face of the war against malaria forever.

I’m happy to say, we are completing a Phase 3 clinical trial on the most advanced malaria vaccine candidate to date: RTS,S. No other vaccine candidate has made it this far in the development process. Walter Reed worked with GSK in the early development of RTS,S in the 1980s. In 2009, a unique public/private partnership involving the PATH Malaria Vaccine Initiative (MVI), GSK and 11 African research centers—including my center in Kombewa—launched this large-scale trial with over 15,000 infant and young child participants.

In the results so far, clinical malaria cases were reduced by about half in young children ages 5 months to17 months and by about a quarter in infants 6 weeks to 12 weeks after 18 months of follow-up. We’re very much looking forward to the trial’s final results at the end of this year or early 2015, which will provide 30 months of follow-up and give us data on the effects of a booster dose.

Looking ahead

So where do we see RTS,S in the months to come?

Later this year, GSK plans to submit a regulatory application for RTS,S to the European Medicines Agency (EMA). If the data and public health information is deemed satisfactory, and the EMA gives a positive opinion, the WHO has indicated that a policy recommendation for the RTS,S malaria vaccine candidate is possible by the end of 2015. This would pave the way for local regulatory submissions and decisions by African nations regarding implementation of the vaccine through their national immunization programs.

With this in mind, in Kenya, as in other countries in my part of Africa, like Tanzania and Uganda, efforts are already underway to ensure a timely decision on whether to adopt this new tool, if it is licensed and recommended for use. If we have an effective and approved tool for use against this terrible disease, I’d hate to see it sit on the shelf when I do my rounds in the pediatric ward full of sick kids.

It’s been a very gratifying experience to work with WRAIR and our partners on this “big picture” intervention—a vaccine—for one of our biggest and most persistent public health problems—malaria.

Dr. Lucas Otieno is a medical doctor working as a Research Officer and Certified Physician Investigator with the Kenya Medical Research Institute (KEMRI)/Walter Reed Project in Kenya. He is currently a Principal Investigator for the Phase III malaria vaccine trials of RTS,S.

By: Dr. Muhammed Afolabi

As a family care provider in the densely populated West African city of Osogbo, some 200 kms south of Lagos in Nigeria, up to 6 out of 10 patients attending my clinic between 2002 and 2009 presented with symptoms and signs of malaria. Given various logistical challenges, including poor laboratory facilities and a lack of rapid malaria diagnostic kits, my malaria diagnosis was based on a high index of clinical suspicion.

The anti-malaria treatment I prescribed included various brands of artemisinin-based combination therapy, but my patients usually came back with additional episodes of malaria within two to three weeks of completing their treatment. I then spent more time re-diagnosing and re-treating these patients. And while I routinely encouraged patients to sleep under insecticide-treated bed-nets, they indicated a lack of motivation, telling me they felt like “fish inside a net.” My own family did not escape the distress of recurring malaria episodes. My wife suffered repeated bouts that occurred as frequently as every four weeks, causing her to refer to them as her “monthly sickness.”

“Sadly, though, the reduction in the overall number of cases here appears to be accompanied by waning malaria immunity.”

In mid-2009, fate took us to another city in West Africa—Fajara in the Gambia—where I currently work on a malaria vaccine. While there is no doubt about the bad effects of malaria on the children, pregnant women, and other adults here, we are lucky that malaria control efforts like insecticide-treated nets, indoor residual spraying, and effective antimalarial drugs have brought cases of malaria to a low level. As a result, my wife and other members of my family had no malaria for the first two years of our stay in the city.

Sadly though, the reduction in the overall number of cases here appears to be accompanied by waning malaria immunity in the Gambia. For the past two years, we have seen in our clinics and trial centres, severe forms of malaria among older children and adults—groups who would normally be expected to have developed some degree of natural protection against the disease.

Recently, I’ve observed that the number of patients with malaria in the health centre where I work is increasing by leaps and bounds. I’ve also noticed that these patients have severe malaria and that the hospital beds are occupied by several older children and young adults who would be expected to have developed immunity against severe forms of the disease.  Two of these older children died following episodes of convulsion and loss of consciousness. About the same time, my 10-year old daughter contracted severe malaria, and I was even more deeply touched by the devastating effects of the disease.

“We must continue to expand the use of current malaria control strategies even as we press for expanded malaria research and development efforts.”

Because of the high patient burden and my own family distress occasioned by the scourge of malaria, I have renewed my commitment to working with individuals, communities, and key stakeholders to control this perennial menace. We must continue to expand the use of current malaria control strategies even as we press for expanded malaria research and development efforts, including the development of malaria vaccines.

At the individual level, I work passionately in the search for an effective malaria vaccine. I also plan to do what I can to help to galvanise support for more research funding and support for malaria vaccine trials.

As a scientist, I believe I have a big role to play in this regard. We always assume that stakeholders understand our work, follow our progress, and understand scientific language the way we do; however, they need information to be delivered in a simplified, rational manner. Engagement of scientists with key stakeholders will help to ensure that our important research and development work is well understood and eventually translated into policies and interventions in a timely way—at the appropriate time.